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NEWAH has always implemented WASH programmes in an integrated manner but in the past there was a greater focus on the technical and hardware aspect rather than the software and social components. In the late 90s, the importance of sanitation promotion was realized considering that less than 25% of Nepal's population had access to sanitation facilities. In 1999 a separate sanitation section was established within NEWAH

Most organizations working in the field of sanitation at the time including NEWAH provided some sort of subsidy for latrine construction. Results showed that sanitation coverage still remained low and many of the latrines constructed were not used or well maintained. Besides the households that could afford to construct a latrine also did not, expecting to receive some subsidy. Even in the communities where every household had a latrine, open defecation was still prevalent.

Thus since 2003/04 NEWAH started promoting Community Led Total Sanitation (CLTS) approach, initiating three pilot projects. CLTS is an approach that promotes total sanitation coverage by motivating people to build and use latrines on their own without providing any kind of hardware subsidy. Gradually, CLTS was scaled up in more NEWAH projects. In 2007 an assessment of the CLTS projects suggested that safety nets were necessary to help the poor and landless who were unable to afford building a permanent latrine to build and use one. This led to developing and mainstreaming the Community Led Basic Sanitation for All (CLBSA) approach, a shift towards a pro poor and inclusive sanitation model (a blend of CLTS and NEWAH’s experience on sanitation promotion).

In recent years NEWAH has started promoting the VDC total sanitation campaign by facilitating the principles of CLTS. NEWAH works in close coordination with local bodies to mobilise VDC level funds to reward communities and VDCs declaring themselves as open defecation free. Close coordination is maintained at the VDC level, with all WASH stakeholders and communities to facilitate achievement of total sanitation in a VDC. This strategic movement ultimately aims to contribute in achieving the MDGs and national targets on sanitation that the Government of Nepal has committed to.